Pound of Prevention, Ton of Cure

Weighing the Value of Public Health

By Jo Lynn Orr

UAB Public Health students helped bring visibility to their future profession by taking part in the "This Is Public Health" campaign, placing stickers on examples of public health in action around Birmingham. See more of their handiwork here.

Public health has an image problem. This is somewhat surprising, considering that the field has spent the past hundred years transforming American life for the better. In 1900, the life expectancy of the average American was just over 47 years; a century later, it was 77 years and rising. And according to a 1994 study cited by the Centers for Disease Control and Prevention (CDC), 25 years of this 30-plus year gain in life expectancy can be attributed to advances in public health. Vaccinations, food safety, workplace safety, motor-vehicle safety, infectious disease control, smoking prevention—each of these public health measures has played a part in extending the lives of millions in the United States and around the world.

The trouble is that public health is so broad that it’s almost invisible. “When you think of a doctor, lawyer, baker, or candlestick maker, a specific image immediately comes to mind,” says Max Michael, M.D., dean of the UAB School of Public Health. “That’s not true for public health, which is a collective process involving many individuals. If people think about public health at all, they tend to think about immunizations or restaurant inspections or now about flu or disaster preparedness.” The idea of public health as something needing to be taught and studied is almost completely nonexistent in the minds of the public. “It’s a real marketing challenge,” says Michael. “We have to create a clear mental and visceral image that the public can latch onto.”

Down the Pipes

One of Michael’s favorite images is that of a rusty water pump in Victorian England. “In their first year of study, public health students learn about John Snow, a 19th-century London physician who halted a cholera epidemic by removing the handle of the Broad Street water pump” and thereby removing the source of infection, Michael says. “The infrastructure at the time—sewers and drinking water—were uncoordinated and collapsing. Because of John Snow, city leaders realized that you can’t mix sewage and water without brewing deadly disease outbreaks.

“Today, we take it for granted that we can check into a 2,000-room hotel in New York City and turn on the faucet and go to the bathroom without those two systems mixing. Just those two things alone ensure the healthy existence of that small city of 2,000 rooms. That’s public health.”

But that’s not all. A recent outreach effort from the Association of Schools of Public Health encouraged students to plant bright-red “This is Public Health” stickers on everyday examples of public health in action. UAB students have documented their handiwork on the Flickr photo-sharing Web site, tagging everything from blood drives and fun runs to manhole covers, bike racks, park benches, and parking enforcement vehicles. (“The enforcement of parking codes keep sidewalks and crosswalks clear,” a caption notes.)

On the Front Lines and Behind the Scenes

So what exactly is public health? The field can be broadly divided into two parts, Michael says: professional and academic. “Professional public health practitioners work on the front lines, providing disease surveillance, clean water and air, restaurant inspections, making sure dogs and cats have their rabies shots—those types of things,” says Michael. They also staff federal agencies such as the CDC, which works to promote health and prevent disease in communities throughout the nation.

On the academic side, schools of public health train professionals to work in health departments, industry, and the government. They also conduct research, gathering data to help policymakers make better decisions, Michael says. “For example, in searching for clues about a particular kind of cancer, public health researchers will collect statistical information showing where that cancer resides and which populations are affected,” explains Michael. “Data might show that the cancer is more prevalent in the South among African Americans, for instance,” and that gives policymakers vital information on the most effective and efficient means to confront the problem.

“There’s a constant back and forth between the academic and professional sides,” Michael says. The dialogue is especially important, he notes, when it comes to addressing widespread problems such as obesity, high blood pressure, and pandemic influenza.

What You Don’t See…

The challenge of public health, Michael continues, lies in its subtlety. Close study often uncovers a complex web of underlying causes behind even the most seemingly straightforward medical problems, such as obesity and diabetes. “Education, housing, neighborhood safety, jobs, and job security—these things are critical to having some control over those epidemics,” Michael says. “Education is especially important—not education about public health, but just basic education. If our children are educated, they will be healthier.

“The greater the gap between the haves and the have-nots, the less healthy a community will be,” Michael adds. “We don’t like to talk about the transfer of wealth in this country, but it’s a fact that in those countries where the bottom half of the population receives more emphasis, the health of the community, the region, and the nation fares better.”

Everyone’s Problem

Today, “there’s a lot of interest in access to care as a public-health concern,” Michael says. “It’s one of the top issues of the Obama administration, which wants to decrease the number of uninsured people in this country through some sort of national health insurance program.”

But while he is pleased to see efforts to expand access to care, Michael is concerned about the effects of the current economic downturn on funding for other public health programs. “Public-health practitioners are struggling with cutbacks in funding,” he says. “For example, I suspect many health departments may be considering cutting back on the number of restaurant inspections they conduct or rethinking how many resources should be expended on water and air tests. On the academic side, we’re struggling with the same problem.”

In the end, every citizen is a primary stakeholder in and beneficiary of public health policies, Michael notes—so it’s in everyone’s best interest to make sure those policies are adequately enacted and funded. “In the end, these decisions affect them, their families, and their communities.”